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Abstract：
OBJECTIVE: To identify and assess the effectiveness of national antibiotic optimization interventions in primary and secondary care in England (2013-2022).
METHODS: A systematic scoping review was conducted. Literature databases (Embase and Medline) were used to identify interventions and evaluations. Reports included the UK AMR Strategy (2013-2018), National Action Plan (2019-2024) and English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports (2014-2022). The design, focus and quality of evaluations and the interventions\' effectiveness were extracted.
RESULTS: Four hundred and seventy-seven peer-reviewed studies and 13 reports were screened. One hundred and three studies were included for review, identifying 109 interventions in eight categories: policy and commissioning (n = 9); classifications (n = 1); guidance and toolkits (n = 22); monitoring and feedback (n = 17); professional engagement and training (n = 19); prescriber tools (n = 12); public awareness (n = 17); workforce and governance (n = 12).Most interventions lack high-quality effectiveness evidence. Evaluations mainly focused on clinical, microbiological or antibiotic use outcomes, or intervention implementation, often assessing how interventions were perceived to affect behaviour. Only 16 interventions had studies that quantified effects on prescribing, of which six reported reductions. The largest reduction was reported with structural-level interventions and attributed to a policy and commissioning intervention (primary care financial incentives). Behavioural interventions (guidance and toolkits) reported the greatest impact in hospitals.
CONCLUSIONS: Many interventions have targeted antibiotic use, each pulling different levers across the health system simultaneously. On the basis of these studies, structural-level interventions may have the greatest impact. Collectively, the combination of interventions may explain England\'s decline in prescribing but direct evidence of causality is unavailable.
METHODS: A systematic scoping review was conducted. Literature databases (Embase and Medline) were used to identify interventions and evaluations. Reports included the UK AMR Strategy (2013-2018), National Action Plan (2019-2024) and English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports (2014-2022). The design, focus and quality of evaluations and the interventions\' effectiveness were extracted.
RESULTS: Four hundred and seventy-seven peer-reviewed studies and 13 reports were screened. One hundred and three studies were included for review, identifying 109 interventions in eight categories: policy and commissioning (n = 9); classifications (n = 1); guidance and toolkits (n = 22); monitoring and feedback (n = 17); professional engagement and training (n = 19); prescriber tools (n = 12); public awareness (n = 17); workforce and governance (n = 12).Most interventions lack high-quality effectiveness evidence. Evaluations mainly focused on clinical, microbiological or antibiotic use outcomes, or intervention implementation, often assessing how interventions were perceived to affect behaviour. Only 16 interventions had studies that quantified effects on prescribing, of which six reported reductions. The largest reduction was reported with structural-level interventions and attributed to a policy and commissioning intervention (primary care financial incentives). Behavioural interventions (guidance and toolkits) reported the greatest impact in hospitals.
CONCLUSIONS: Many interventions have targeted antibiotic use, each pulling different levers across the health system simultaneously. On the basis of these studies, structural-level interventions may have the greatest impact. Collectively, the combination of interventions may explain England\'s decline in prescribing but direct evidence of causality is unavailable.
摘要：
目的：确定和评估英格兰初级和二级保健中国家抗生素优化干预措施的有效性（2013-2022年）。
方法：进行了系统范围评价。文献数据库（Embase和Medline）用于识别干预措施和评估。报告包括英国AMR战略(2013-2018年)，国家行动计划（2019-2024）和英国抗菌药物使用和耐药性监测计划（ESPAUR）报告（2014-2022）。设计，提取了评估的重点和质量以及干预措施的有效性。
结果：筛选了四百七十七项同行评审的研究和13份报告。纳入了103项研究进行审查，确定8个类别的109项干预措施:政策和委托(n=9);分类(n=1);指导和工具包(n=22);监测和反馈(n=17);专业参与和培训(n=19);处方工具(n=12);公众意识(n=17);劳动力和治理(n=12).大多数干预措施缺乏高质量的有效性证据。评估主要集中在临床，微生物或抗生素使用结果，或干预实施，经常评估干预措施如何影响行为。只有16种干预措施进行了量化处方效果的研究，其中六份报告减少。据报告，减少幅度最大的是结构性干预措施，并归因于政策和委托干预措施(初级保健财政激励措施)。据报道，行为干预措施（指南和工具包）对医院的影响最大。
结论：许多干预措施都有针对性的抗生素使用，每个人同时在卫生系统中拉动不同的杠杆。在这些研究的基础上,结构层面的干预可能产生最大的影响。总的来说，干预措施的组合可以解释英格兰处方减少的原因,但尚无因果关系的直接证据.
方法：进行了系统范围评价。文献数据库（Embase和Medline）用于识别干预措施和评估。报告包括英国AMR战略(2013-2018年)，国家行动计划（2019-2024）和英国抗菌药物使用和耐药性监测计划（ESPAUR）报告（2014-2022）。设计，提取了评估的重点和质量以及干预措施的有效性。
结果：筛选了四百七十七项同行评审的研究和13份报告。纳入了103项研究进行审查，确定8个类别的109项干预措施:政策和委托(n=9);分类(n=1);指导和工具包(n=22);监测和反馈(n=17);专业参与和培训(n=19);处方工具(n=12);公众意识(n=17);劳动力和治理(n=12).大多数干预措施缺乏高质量的有效性证据。评估主要集中在临床，微生物或抗生素使用结果，或干预实施，经常评估干预措施如何影响行为。只有16种干预措施进行了量化处方效果的研究，其中六份报告减少。据报告，减少幅度最大的是结构性干预措施，并归因于政策和委托干预措施(初级保健财政激励措施)。据报道，行为干预措施（指南和工具包）对医院的影响最大。
结论：许多干预措施都有针对性的抗生素使用，每个人同时在卫生系统中拉动不同的杠杆。在这些研究的基础上,结构层面的干预可能产生最大的影响。总的来说，干预措施的组合可以解释英格兰处方减少的原因,但尚无因果关系的直接证据.
